Laboratory Benefit Management Program
What is the Lab Benefit Management Program?
UnitedHealthcare’s Lab Benefit Management (LBM) program is improving quality and advancing patient safety. It gives physicians real time evidence-based guidelines and helpful information about lab quality and efficiency standards at the time tests are ordered. A new online ordering system makes it easier for doctors to choose in-network labs and encourages more consistent use of evidence-based guidelines, reducing disparities in patient care and often lowering a patient’s out-of-pocket costs. The program applies to 79 commonly ordered lab tests.
Where is the lab program being used?
The LBM program is currently being piloted with physicians in Florida and Texas. It is only applicable to UnitedHealthcare members enrolled in fully insured commercial health plans at this time.
Has UnitedHealthcare been working with physicians for their input on the program?
Yes, the LBM program is based on broad input from the provider community to ensure it’s as easy as possible for physicians and labs to use while advancing quality and patient safety. For example:
- We’ve held hundreds of meetings with physicians, pathologists, and their professional societies over the last two years in Florida to effectively build the program with their input.
- A new Scientific Advisory Board was created in early 2016 based on feedback from the provider community, comprised of primary care physicians and physician specialties who frequently order lab services. This Board meets regularly to help evaluate pilot results and advise on lab quality criteria.
- We rely on 20 years of clinical evidence from external, independent medical sources so physicians have evidence-based recommendations at their fingertips when they order a lab test.
What were the results from the pilot program in Florida?
We have seen some great results from the pilot program in Florida, which launched in October 2014.
- 67% – physicians’ compliance with evidence-based guidelines when ordering lab tests has increased to 67 percent, up from 46 percent just one year earlier, improving the quality of care.
- 19% – average savings in out-of-pocket costs for UnitedHealthcare members enrolled in the pilot, the result of using in-network labs and higher quality, lower cost facilities.
- 95% of UnitedHealthcare members are now using in-network labs, helping those individuals maximize their benefits coverage and reducing their out-of-pocket costs.
- 75%-80% of physicians are using the online ordering system, illustrating increased familiarity and comfort with providing lab notifications.
Aren’t all labs pretty much the same?
There continues to be significant variation in both the quality and cost of lab services, oftentimes even within the same community. And physicians and patients have no way to compare the quality of lab services today, making it difficult to support informed health care decisions. Consider the following independent studies:
- A 2014 survey of U.S. physicians found that 73 percent say the frequency of unnecessary tests and procedures is a serious problem, and 85 percent say having specific, evidence-based recommendations they can use with patients would be an effective solution (Robert Wood Johnson Foundation).
- A March 2015 JAMA study found that pathologists disagree 25 percent of the time in their interpretation of breast biopsies to diagnose breast cancer, underscoring the value of a second opinion for more complex lab results.
Does anything change for me as a UnitedHealthcare members when I need lab work performed?
No, the LBM program does not change your benefits coverage or access to UnitedHealthcare’s full network of participating labs. The (LBM) program was created to improve quality and advance patient safety by giving physicians real time evidence-based guidelines when ordering lab services and making it easier for them to send UnitedHealthcare members to in-network labs.
What is the Physician Decision Support tool?
Physician Decision Support (PDS®) is the name of the new online system for ordering lab tests. Physicians log into PDS® or access it through their EHR system (13 EHRs are integrated today) to order a lab test for UnitedHealthcare patients if it is among the 79 tests included in the program. Check out our Fact SheetOpens a new window that illustrates how to order a lab test using PDS®, which generally can be done in five easy steps.
Does this program impose an administrative burden on physicians?
The average physician orders 1.8 tests per month requiring advanced notification. The time it takes to complete the advanced notification is minimal, and there are no additional administrative costs to access or use the Physician Decision Support (PDS) tool. Our pilot in Florida showed the following patterns:
- On average, it took 72-seconds (range of 50 – 123 seconds) to complete a lab test order without advanced notification.
- On average, it took 30 seconds to order lab services using the PDS tool and answering questions about evidence-based guidelines (range of 10 – 44 seconds).
- On average, it took about 14 seconds to order lab services using the PDS tool when no questions are prompted (range of -4 – 24 seconds).
The reason for faster incremental time under the BeaconLBS portal is due to searching on a smaller population of tests (the list of advanced notification tests is 79 tests, compared to the full test directory of more than 2,000 tests.
Is this a new pre-authorization program for when lab tests are ordered?
No, this is a pre-notification program, not pre-authorization, which means UnitedHealthcare is simply requesting a notification when one of 79 different lab tests included in the LBM program are ordered. This notification enables us to share important evidence-based guidelines for different lab tests at the time they’re being ordered, improving quality and lowering costs. Based on a review of the tests Florida physicians commonly ordered across most specialties, on average only 2-3 lab test orders per month are among the 79 that require pre-notification.
Will the LBM program be used for all lab tests ordered for UnitedHealthcare members?
Only 79 tests are included in the LBM program. Physicians must use the PDS® tool if they’re submitting a lab service for one of these 79 tests. Based on a review of the lab services our Florida network physicians commonly order across most specialties, on average only 2-3 lab orders per month were among the 79 tests requiring pre-notification. Some specialties, however, may have higher utilization of these 79 tests.
What is a Lab-of-Choice™?
“Lab-of-Choice™” is how we identify preferred labs within UnitedHealthcare’s broader lab network that meet certain quality and accreditation criteria and offer lower overall costs. Just as health care’s Triple Aim encourages better care, a better patient experience and lower costs, a Lab-of-Choice™ has shown a commitment to these same standards. However, physicians can send UnitedHealthcare members to any lab participating in our network.
If LabCorp runs the LBM program, does that mean physicians can only use LabCorp facilities?
In 2019, UnitedHealthcare will be growing its national network of participating laboratory providers to better support our members and the care providers who order laboratory services. LabCorp will remain in‑network and beginning Jan. 1, 2019, Quest Diagnostics will also be an in-network laboratory care provider for all UnitedHealthcare members.
How does the LBM program encourage greater use of in-network labs?
The PDS® system includes a pre-populated drop down menu of in-network labs for the patient’s insurance plan, making it much easier for physicians to send their patients to participating labs. Labs meeting higher quality designations and lower overall cost are listed first (referred to as Labs-of-Choice™), but all contracted labs participating in UnitedHealthcare’s network are listed and can be used by patients. UnitedHealthcare members in the Florida pilot have seen 19% lower out-of-pocket costs on average because of more frequent use of in-network labs. Out-of-network labs often charge significantly more and members are not maximizing the insurance coverage available to them.